中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
7期
413-417
,共5页
陆任华%方燕%高嘉元%蔡宏%朱铭力%张敏芳%戴慧莉%张伟明%倪兆慧%钱家麒%严玉澄
陸任華%方燕%高嘉元%蔡宏%硃銘力%張敏芳%戴慧莉%張偉明%倪兆慧%錢傢麒%嚴玉澄
륙임화%방연%고가원%채굉%주명력%장민방%대혜리%장위명%예조혜%전가기%엄옥징
肾损伤,急性%住院患者%发生率%危险因素%病因
腎損傷,急性%住院患者%髮生率%危險因素%病因
신손상,급성%주원환자%발생솔%위험인소%병인
Acute kidney injury%Hospitalized patient%Incidence%Risk factor%Etiology
目的 分析住院患者中急性肾损伤(AKI)的流行病学特点及AKI发生的危险因素,为临床更好地认识和预防AKI、改善预后提供依据.方法 应用医院实验室网络系统筛选2008年1月至12月上海市一家三级综合性医院所有住院患者;以急性肾损伤网(AKIN)推荐的AKI定义选择病史完整的AKI患者组成研究队列,回顾性分析AKI住院患者的发生率、病因及分布特点;Logistic回归分析影响AKI严重程度的危险因素.结果 符合入选标准的住院AKI患者共934例、发生AKI1001例次,住院患者的AKI发生率为2.4%(934/38734).患者男女比例为1.88∶1,年龄(60.82±16.94)岁,AKI发生率随年龄升高逐渐增高,其中内科331例(占35.4%),外科592例(占63.4%),妇产科11例(占1.2%).肾前性、肾性和肾后性AKI分别占52.0%、44.7%和3.3%.急性肾小管坏死(ATN,占37.5%)、绝对血容量不足(占33.6%)和相对血容量减少(占13.4%)是住院患者发生AKI最常见的原因.多因素Logistic逐步回归分析显示:合并慢性肾脏病(CKD)史[相对比值比(DR)=2.085,95%可信区间(95%CI)1.536～2.830,P<0.01]、使用肾损伤药物(DR=1.438,95%CI 1.087～1.901,P<0.05)及合并肾外器官衰竭(OR=1.327,95%CI 1.014～1.737,P<0.05)是早期AKI发展成中重度AKI的独立危险因素.结论 AKI是住院患者常见的临床综合征,发生率随年龄升高逐渐增加;肾前性AKI和ATN是住院AKI最常见的原因;合并CKD、肾损伤药物应用和肾外器官衰竭是发展成中重度AKI的独立危险因素.
目的 分析住院患者中急性腎損傷(AKI)的流行病學特點及AKI髮生的危險因素,為臨床更好地認識和預防AKI、改善預後提供依據.方法 應用醫院實驗室網絡繫統篩選2008年1月至12月上海市一傢三級綜閤性醫院所有住院患者;以急性腎損傷網(AKIN)推薦的AKI定義選擇病史完整的AKI患者組成研究隊列,迴顧性分析AKI住院患者的髮生率、病因及分佈特點;Logistic迴歸分析影響AKI嚴重程度的危險因素.結果 符閤入選標準的住院AKI患者共934例、髮生AKI1001例次,住院患者的AKI髮生率為2.4%(934/38734).患者男女比例為1.88∶1,年齡(60.82±16.94)歲,AKI髮生率隨年齡升高逐漸增高,其中內科331例(佔35.4%),外科592例(佔63.4%),婦產科11例(佔1.2%).腎前性、腎性和腎後性AKI分彆佔52.0%、44.7%和3.3%.急性腎小管壞死(ATN,佔37.5%)、絕對血容量不足(佔33.6%)和相對血容量減少(佔13.4%)是住院患者髮生AKI最常見的原因.多因素Logistic逐步迴歸分析顯示:閤併慢性腎髒病(CKD)史[相對比值比(DR)=2.085,95%可信區間(95%CI)1.536～2.830,P<0.01]、使用腎損傷藥物(DR=1.438,95%CI 1.087～1.901,P<0.05)及閤併腎外器官衰竭(OR=1.327,95%CI 1.014～1.737,P<0.05)是早期AKI髮展成中重度AKI的獨立危險因素.結論 AKI是住院患者常見的臨床綜閤徵,髮生率隨年齡升高逐漸增加;腎前性AKI和ATN是住院AKI最常見的原因;閤併CKD、腎損傷藥物應用和腎外器官衰竭是髮展成中重度AKI的獨立危險因素.
목적 분석주원환자중급성신손상(AKI)적류행병학특점급AKI발생적위험인소,위림상경호지인식화예방AKI、개선예후제공의거.방법 응용의원실험실망락계통사선2008년1월지12월상해시일가삼급종합성의원소유주원환자;이급성신손상망(AKIN)추천적AKI정의선택병사완정적AKI환자조성연구대렬,회고성분석AKI주원환자적발생솔、병인급분포특점;Logistic회귀분석영향AKI엄중정도적위험인소.결과 부합입선표준적주원AKI환자공934례、발생AKI1001례차,주원환자적AKI발생솔위2.4%(934/38734).환자남녀비례위1.88∶1,년령(60.82±16.94)세,AKI발생솔수년령승고축점증고,기중내과331례(점35.4%),외과592례(점63.4%),부산과11례(점1.2%).신전성、신성화신후성AKI분별점52.0%、44.7%화3.3%.급성신소관배사(ATN,점37.5%)、절대혈용량불족(점33.6%)화상대혈용량감소(점13.4%)시주원환자발생AKI최상견적원인.다인소Logistic축보회귀분석현시:합병만성신장병(CKD)사[상대비치비(DR)=2.085,95%가신구간(95%CI)1.536～2.830,P<0.01]、사용신손상약물(DR=1.438,95%CI 1.087～1.901,P<0.05)급합병신외기관쇠갈(OR=1.327,95%CI 1.014～1.737,P<0.05)시조기AKI발전성중중도AKI적독립위험인소.결론 AKI시주원환자상견적림상종합정,발생솔수년령승고축점증가;신전성AKI화ATN시주원AKI최상견적원인;합병CKD、신손상약물응용화신외기관쇠갈시발전성중중도AKI적독립위험인소.
Objective To investigate the epidemiology and the risk factors of acute kidney injury (AKI)in hospitalized patients in order to help clinicians better understand and prevent AKI.Methods All patients hospitalized in Renji Hospital of Shanghai Jiao Tong University,which is a three-level General Hospital in Shanghai,during January to December of 2008 were screened by Lab Administration Network.Study group was comprised of the patients with full clinical data of AKI,as defined by Acute Kidney Injury Network(AKIN).The incidence,etiology and distribution characteristics of hospitalized patients with AKI were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors in severity of AKI.Results Nine hundred and thirty-four patients suffering from AKI for 1001 episodes were enrolled.The incidence of AKI in hospitalized patients was 2.4%(934/38734).The ratio of male to female was Three hundred and thirty-one(35.4%)patients with AKI were found in medical department,592(63.4%)patients in surgical department and 11(1.2%)patients in department of gynecologic and obstetrics.Analysis of the causes of AKI showed that pre-AKI accounted for 52.0%,followed by renal parenchyma AKI (44.7%)and postrenal AKI(3.3%).The most common reason for AKI was acute tubular necrosis(ATN,37.5%),followed by absolute(33.6%)and relative inadequacy of blood volume(13.4%).Multivariate logistic regression analysis showed that chronic kidney disease(CKD)[odds ratio(OR)=2.085,95%confidence interval(95%CI): 1.536-2.830,P<0.01),renal injurious drugs(OR=1.438,95%CI:1.087-1.901,P<0.05),and failure of organs other than kidney(OR=1.327,95%CI: 1.014-1.737,P<0.05)were independent risk factors for stage Ⅰ-Ⅲ AKI.Conclusion AKI is one of the most common clinical syndromes in hospitalized patients.With the increase of age,the incidence increases gradually.The most common reasons for hospitalized AKI are pre-AKI and ATN.CKD,renal injurious drugs and failure of other organs are independent risk factors of medium to serious AKI.
